Failure to Implement and Adhere to Antibiotic Stewardship Program
Penalty
Summary
Facility staff failed to implement an effective, facility-wide antibiotic stewardship program, as evidenced by interviews, clinical record reviews, and documentation. The Infection Preventionist (IP) described a process using McGeer criteria to determine the need for antibiotics, but acknowledged that antibiotics were sometimes prescribed even when residents did not meet these criteria, often at the discretion of the physician. Tracking forms revealed that, over several months, a significant number of residents were prescribed antibiotics without meeting McGeer criteria, and documentation was often incomplete regarding whether criteria were met prior to initiating treatment. For one resident, antibiotics were prescribed for urinary symptoms, and later, duplicate antibiotic therapy was initiated without documented discussion of this with the medical provider. The resident subsequently received additional antibiotics for a positive urinalysis without documented symptoms, and the IP's event report indicated that McGeer criteria were not met. There was no evidence that the IP or other staff discussed the lack of criteria with the prescribing provider. Another resident was prescribed antibiotics for acute bronchitis based on symptoms of cough and congestion, but there were no preceding notes documenting symptoms, and the IP's event report again indicated that McGeer criteria were not met. Additionally, despite an active order to test for COVID-19 as needed, there was no documentation that the resident was tested after developing respiratory symptoms. The facility's policy required collaborative oversight of antimicrobial stewardship, but the process was not consistently followed, and there was a lack of communication among staff and providers regarding adherence to established criteria.